Provider Demographics
NPI:1427067487
Name:MCCOY, JENNIFER J (DPM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:MCCOY
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12257 S PLACER ST UNIT 2901
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-2713
Mailing Address - Country:US
Mailing Address - Phone:917-331-9002
Mailing Address - Fax:
Practice Address - Street 1:9035 S 700 E STE 200
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2412
Practice Address - Country:US
Practice Address - Phone:917-331-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006067213E00000X
UT13346930-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0889694OtherCIGNA
5C5573OtherHEALTHNET